1

INTRDUCTION

The etiopathogenesis of yakritodara and plihodara are similar except the anatomical location. It is classified into five types as vataja, pittaja, kaphaja, sannipataja and raktaja and again based on the etiopathogenesis it is classified into chyuta and achyuta yakrut vriddhi. One by chyuta (displacement) and other by achyuta vriddhi (not displaced). Chyuti means displacement from its own place. In achyuta type, dusta rasadi dhatu is considered in the pathogenesis of yakrutodara/pleehodara. Vardhaman Pliha (There will be progressive enlargement of the Yakrit/Pleeha. Liver/spleen becomes stony hard initially and on palpation feels like a tortoise back and if neglected the enlarging yakrit puts pressure and expands over the kukshi, remaining part of the abdomen and agniadhisthana, dourbalya (debility), arochaka (lack of taste in the mouth), avipaka (indigestion), varchagraha (Constipation), mutragraha (Retention of urine), tamapravesha(Darkness infront of the eyes), pipasa (excessive thirst), angamardha (malaise), chardi (vomiting), moorcha (Transient loss of consciousness), angasada (Tiredness of body parts), kasa (cough), swasa(dyspnoea), mridu jwara (mild fever),anaha (flatulence), agninasha(loss of appetite), karshya (emaciation), asyavairasa (abnormal taste in the mouth), parvabheda(pain in joint of the digits) ,Koshtashoola(abdominal pain),Vatashoola (abdominal pain due to morbid vata), Udara arunavarana (red discoloration of the abdomen) Udara vivarna, (discoloration of the abdomen) udara neelaharitaharidra raji (appearance of network of veins having blue, green or yellow color).[8]

Sneha-swedana, virechana, niruha and anuvasana basti is advised. Siravyadhana in left arm is also a part of its treatment. Pippali, guda haritaki, kshara and arishta preparations are used. Pippali Vardhaman rasayana can be prescribed.

Pleehodara, according to Ayurveda is one among the eight types of Udara Roga i.e. abdominal enlargement. When spleen enlarges beyond normal dimensions, it presents as an abdominal enlargement. Pliha means spleen. Udara means abdomen. Therefore Plihodara means enlargement of spleen in the abdomen causing its enlargement. It is often called as just Pliha.

If the word Pliha is used in the context of explanation of disease it means ‘enlargement of spleen’. Else, the word just means the ‘organ spleen’. Spleen along with liver is considered as roots of origin of channels of formation and transportation of blood. It is said that the rasa tissue on reaching the liver and spleen get colored red by the action of ranjaka pitta and transformed into blood tissue.

Yakrutodara means enlargement of liver. If there is similar (to spleen enlargement) enlargement on the right side of the abdomen, with the above said signs and symptoms, it will be called as Yakrutodara.

The causes, signs and symptoms and treatment of enlargement of liver is said to be similar to that of enlargement of spleen. Therefore there is no separate description of enlargement of liver in Ayurveda texts. The explanation is clubbed in the discussion of plihodara itself.

Liver disease is a broad term which explains varieties of diseases.simple terms liver disease is any condition which causes inflammation of the liver cells (hepatic cells) or damage to the liver tissue. Ultimately the functions of this master organ is decreased and hence indirectly various Gastro -Intestinal disturbances are resulted.

Liver is responsible for many functions related to different systems, such as fat metabolism, production of proteins for blood plasma, storing and releasing of glucose as and when needed, removing bacteria from the blood stream, providing immunity factors etc. Physical or functional damage to the liver can cause significant hindrance to the related body functions of different systems. Hepatic disease is a broad term overs all the potential problems that cause the liver to fail to perform its designated functions.

In modern science liver disorders are categorised based upon cause and effect,

Cause for liver disease include –

infections, injury, exposure by toxic compounds, genetic defects etc.

Among the effects, inflammatory changes, fatty changes of liver, obstructions, clotting abnormalities and liver failure are pointed out in majority of the cases.

In Ayurveda, liver disorders are grouped together and termed as Yakrit vikara. Yakrit means liver and vikara refers to disorder or derangement, disfigure or diseased condition.

According to Sushruta, the organ liver is formed from the blood (rakta) during the embryonic stage. It is considered to be the main site of blood. Both the Acharyas Charaka and Sushruta referred 3000 years back itself, as the site of colour responsible –bile variety (ranjaka pitta) even before body dissection and circulatory study in modern medicine.

2

LAKSHANA

1. Daurbalya -Weakness, Aruchi -anorexia,

Vipaka-indigestion, Varchamutragraha – retention of stool and urine,

Tamahpravesha – entering into darkness,

Pipasa -excessive thirst, Angamarda -malaise,

Chardi -vomiting, Murchha -fainting,

Angasada- prostration, Kasa -cough,

Shwasa-dyspnoea, Mrudujwara -mild fever,

Anaha (immobility of wind in the abdomen),

Agni nasha -loss of the power of digestion,

Karshya – emaciation, Aasyavairasya – distaste in the mouth,

Parvabheda -pain in finger joints, Kosthavatashula -distension of alimentary tract by wind and colic pain.

2. Shyavaarunaudara -Redness or discolouration of the abdomen and

3. Appearance of net-work of veins having blue, green or yellow colour

Similarly signs and symptoms are manifested by the enlargement of liver (Yakrddalyudara) which is located in the right side of abdomen. Since its etiology, signs and symptoms and treatment are similar to those of Plihodara (splenic enlargement), it is included in the description of the latter.

Most times an enlarged liver may not cause any symptoms.

When a liver disease causes enlargement of liver, it may present the below mentioned symptoms –

• Pain in the abdomen, and abdominal mass

• Increasing abdominal size

• Feeling of fullness or discomfort in your belly

• Fatigue and weakness

• Nausea and vomiting

• Jaundice

• Weight loss

• Poor appetite

• Muscle aches

• Itching

• Swelling of feet and legs

• Easy bruising

If the symptoms are too troublesome you need to see a doctor as soon as possible. Below mentioned symptoms require immediate medical attention –

• Severe abdominal pain

• Jaundice and fever

• Shortness of breath

• Black, tarry stools

• Bright red blood in stools

• Bloody or coffee ground vomit

These symptoms might indicate medical emergency.

3

NIDANA

The entire body and body parts getting stimulated and agitated (jerk, shake violently) following one of the below mentioned events –

• Riding on animals immediately after taking food

• Getting indulged in many kinds of physical activities immediately after intake of food

Extreme emaciation of the body occurring due to one or more of the below mentioned factors –

• Excessive sexual intercourse

• Lifting heavy weights

• Excessive walking

• Suffering from vomiting or other diseases for long duration

Due to the above said etiological factors, the spleen located in the left side of the abdomen will get displaced from its place and undergo excessive growth. Alternatively the increased quantity of rasa tissue will lead to the formation of excessive blood tissue. This increased blood will cause enlargement of spleen.

CAUSATIVE FACTORS FOR LIVER DISORDERS (YAKRIT VIKARA):

Madyapana (Alcohol intake)

Vegadharana (Suppression of natural urges)

Ushna teekshna ahara (intake of spicy and penetrative food and beverages)

Guru abhishyandi bhojana (heavy and blocking agents)

Diwaswapna (day sleep)

Ratri jagarana (night awakening)

Kshata (injury) etc

CAUSE (MODERN)

1. LIVER DISEASES

• Liver cirrhosis

• Hepatitis A, B and C

• Hepatitis caused by infectious mononucleosis

• Alcoholic fatty liver disease

• Nonalcoholic fatty liver disease

• Amyloidosis – abnormal protein accumulation in liver

• Wilson’s disease – genetic disorder, marked by copper accumulation in the liver

• Hemochromatosis – caused due to iron accumulation in the liver

• Gaucher’s disease – caused by fatty substances accumulating in the liver

• Liver cysts – fluid filled pockets in the liver

• Hemangioma and adenoma – presence of non-cancerous liver tumors in the liver

• Toxic hepatitis

• Obstruction of gallbladder or bile ducts

2. CANCERS

• Secondary / metastatic liver carcinomas

• Leukemia

• Lymphoma

• Liver cancer

• Multiple myeloma

3. PROBLEMS OF HEART AND BLOOD VESSELS

• Budd-Chiari syndrome – caused by blockage of veins of liver

• Heart failure

• Pericarditis – inflammation of tissue surrounding the heart

• Congestive hepatomegaly – Congestive heart failure can cause blood to back up into the hepatic veins. These are the veins that help drain blood from the liver. When they back up, liver will become congested and grow larger. This is called as congestive hepatomegaly.

4. CONGENITAL CONDITIONS

• Hemolyticanemia

• Polycystic liver disease

• Sickle cell disease

• Hereditary fructose intolerance

5. INFECTION

• Glandular fever (infectious mononucleosis)

• Hepatitis

• Liver abscess / Pyogenic abscess

• Malaria

• Amoeba infections

• Hydatid cyst

• Leptospirosis

• Actinomycosis

6. BILIARY CONDITIONS

• Primary biliary cirrhosis

• Primary sclerosing cholangitis

7. METABOLIC DISORDERS

• Cholesteryl ester storage disease

• Porphyria

• Niemann Pick disease

• Glycogen storage disease

(Haemochromatosis, Wilson’s disease, Non-alcoholic fatty liver disease – mentioned in liver diseases are also included here)

8. DRUGS

• Alcohol abuse

• Drug induced hepatitis

9. OTHER CONDITIONS

• Granulomatous conditions – Sarcoidosis

• Zellweger’s syndrome

• Hunter’s syndrome

Carnitine palmitoyltransferace I deficiency

4

RISK FACTORS

Having a liver disease is the greatest risk factor for hepatomegaly. You are likely to develop enlargement of liver if you have a liver disease. Below mentioned are the factors and conditions which tend to increase your risk of getting liver problems.

• Autoimmune disorders afflicting the liver

• Taking large amounts / doses of medicines, vitamins or supplements predisposes to hepatomegaly. Overdose of acetaminophem is the commonest cause for acute liver failure in US. Reading the labels and knowledge of what medicines or supplements causes liver enlargement will help.

• Infectious diseases – including viral, bacterial or parasitic diseases increases risk of liver damage

• Inflammatory bowel disease

• Hepatitis viruses

• Poor eating choices and habits – unhealthy foods and those rich in excess fat or sugar are risk factors for liver damage

• Being overweight

• Sickle cell disease

LIFESTYLE FACTORS

• Excessive use of alcohol

• Blood transfusions

• Tattooing

• Blood transfusions

• Unprotected sex

• Traveling to foreign countries associated with risks for malaria

• Taking herbs like ma huang, comfrey and mistletoe in excess

5

SAPEKSH NIDANA

PLEEHODARA -non bellotable lump,sharp edge & splenic notch absent, ribs & spleen k bich rikt sthan nhi hota

VRUKKA ARBUDA - bellotable lump,ribs & spleen k bich rikt sthan hota

6

TYPES OF YAKRUTODARA

IN AYURVEDA LIVER DISORDERS ARE CLASSIFIED MAINLY UNDER TWO HEADINGS-

Mlana yakrit (decreased functions or improper functions or shrinkage) and

Yakrit vriddhi (enlarged liver)

Depending upon the severity of the affliction the features are exhibited.

FEATURES OF LIVER DISORDERS (YAKRIT VIKARA)

MLANA YAKRIT (REDUCED LIVER FUNCTIONS) –

Shakrit apravritti (constipation)

Pittaalpata (reduced biliary functions)

Atitrushna (excess thirst)

Avila mutrata (turbidity of urine)

Kardanma deha prabha (loss of lustre and complexion)

Panduta (anaemia)

Adhmana(distention of abdomen)

Agnimandya (loss of digestive capacity)

Chardi (vomiting)

Avasada (debility)

Tiktodgara (bitter regurgitation)

Jihwa liptata (coated tongue)

Udgara bahulya (belching)

FEATURES OF YAKRIT VIKARA (ENLARGED LIVER)-

Asthi shoola ( pain in bones and joints)

Dakshina skandha shoola ( pain in right shoulder)

Sakthi shoola (pain in the flanks/waist)

Dakshina bahu jadya (numbness in the right shoulder)

Kasa (cough)

Jwara(fever)

Mala vaivarnya (discoloration of the stool)

Tiktasyata (bitterness of the mouth)

Arati (loss of interest)

Lohita mootrata (yellow or red discoloration of the urine)

Bala hani (lethargy)

Vid badha(constipation)

Peetakshata (yellow discoloration of the eyes)

Vama parshwa shayanashaktata (difficulty to lie down in left sided position)

Nidranasha (loss of sleep)

Kamala (jaundice)

Toda(pricking sensation)

Bheda (splitting pain)

Daha (burning sensation)

Trishna (thirst)

Shotha (oedema) etc

ACCORDING TO MODERN MEDICINE TYPICAL FEATURES OF LIVER DISORDERS ARE –

Jaundice, fatigue, itching, loss of appetite, nausea, vomiting, pain in the right upper abdominal quadrant, abdominal distention and intestinal bleeding in severe cases.

Now a days liver function tests make the diagnosis of liver disorders simple and more accurate. It becomes mandatory to understand the nature of the injury and to rule out in someone who is suspected liver disease due to unknown etiology or secondary to other systemic disorders.

7

PRICIPAL OF CHIKITSA

Line of Treatment in liver diseases:

Precipitating factors should be avoided. Patients are advised to avoid exertion and heavy work. Fat restricted food and protein rich food are recommended.

In cases of Hypoglycemia, intermittent administration of glucose is suggested.

In Ayurveda,

Deepana (Carminatives)

Pachana (Digestives),

Mashodhaka (Laxatives) and

Pittavirechaka (Cholegogues) herbs are recommended.

Panchakarma:

Vamana and Virechana treatments are used mainly in the treatment of liver disorders. They help to expel out aggravated Kapha and Pitta Dosha.

TREATMENT (MODERN)

The treatment for enlarged liver involves treating the condition or disease that is causing it. Below mentioned are some of the recommended treatments –

• Medications and treatments for liver failure / infections

• Chemotherapy, surgery or radiation for liver cancer

• Liver transplant when there is liver damage

Lifestyle changes

• Quitting alcohol or any other drugs

• Eating healthy diet

• Doing regular exercise

• Losing weight if you are obese or overweight

Prevention

• Following healthy lifestyle

• Maintaining a healthy weight

• Managing blood sugar levels

• Restriction or avoiding alcohol intake

• Quit smoking

• Taking supplements in consultation with doctor

• Following recommendations for safe handling if you are working with chemicals, insecticides or aerosolized cleaners

If the hepatomegaly is discovered earlier, there is a better outcome in the treatment. Recovery and reduction of symptoms also depends on the scale of underlying causes of hepatomegaly.

8

DIAGNOSIS

PHYSICAL EXAMINATION – Liver enlargement is usually diagnosed by your physician while feeling / examining your abdomen. Enlarged liver is felt during palpation and percussion of abdomen.

OTHER TESTS AND PROCEDURES –

Blood tests – to determine liver enzyme levels and to identify the viruses causing enlargement of liver

Imaging tests – CT scan, USG or MRI

Magnetic resonance elastography – uses sound waves to create a visual map of the liver tissue stiffness. This map is called elastogram. This is now days considered as an alternative to liver biopsy and is noninvasive.

Liver biopsy – may be advised to find out the cause for liver enlargement.

WHOLESOME DIET AND HABITS IN LIVER DISORDERS (YAKRIT VIKARA):

Red rice (Shasthika shali)

Sugar cane juice (Ikshurasa)

Alabu (Bottle gourd)

Sweet and bitter substances (Madhura tikta bhojana)

Light food (Laghu ahara)

Vishrama (Rest). Make sure to sleep for at least 8 hours /day.

Tendercocnut water (Narikela jala)

Raisins (Draksha)

Drink at least 2 litres of water per day.

UNWHOLESOME DIET AND HABITS IN LIVER DISORDERS (YAKRIT VIKARA):

Spicy and fried food (Teekshna-Ushna-Tailakta bhojana)

Lavana (Salt intake in excess)

Sarshapa (Mustard)

Madyapana (Alcohol intake)

Ratri jagarana (Night awakening)

Avoid – high fat foods, deep fried food stuff, aerated drinks, alcohol.

GOOD FOODS FOR LIVER:

Yava – Barley

Godhuma – Wheat

Jangala Mamsa Rasa – Flesh or meat soup of animals living in dry lands

Mudga – Green Gram

Aadhaki – Cajanus cajan (Pigeon pea)

Masura – Red lentils

BAD THINGS FOR LIVER:

Vahnim-aatapam – Exposure to fire, sun,

Ayasa – Excessive / strenuous exercises or activities

Pittalam – Food and activities which increase Pitta

Maithunam – Excessive indulgence in sex

Krodha – Anger and extremes of emotions

Adhwagamanam – Excessive walking

1. FORMULATIONS FOR HEPATO-SPLENOMEGALY FROM YOGARATNAKARA

Sindhvadi Churna

Yavanyadi Churna

Laghu Hingwadi Churna

Shankhanabhi Churna

Vidangadi Churna

Rohitakadi Kalka

Sharapunkha mula kalka

Shalmali Pushpa Kwatha

Dravanti Nagavati

Kshara Bhavita Pippali

Chitrakadhya Ghrita

Maharohitakam Ghritam

Pippalyadi Ghrita

3. USEFUL CLASSICAL FORMULATIONS

• Arogyavardhini Rasa

• Sarvajwarahara Lauha

• Yakrutplihari Lauha

• Punarnavadi Mandura

• Punarnavadi Kashaya

• Saptasara Kwatha

• Rohitakarishta

• Kumaryasava

• Rajata Bhasma

• Loha Bhasma

• Kasisa Bhasma

• Yava Kshara

• Manibhadra Guda

• Dashamula Haritaki

• Dadimadi Ghrta

• Gandharvahastadi Taila

HOME REMEDIES FOR HEPATIC DISORDERS:

1. Ayurvedic remedy for liver diseases –

2. 1 – 2 grams of Long pepper powder is boiled in half a cup of milk, filtered and consumed once or twice a day before food

3. Juice of Bhumi Amalaki (Phyllanthus niruri) is consumed daily in the morning, empty stomach, in a dose of 5 – 15 ml

Liver being a master organ of the body when its structure or functions are altered, it produces serious effects. So care should be taken so as to prevent from any kind of liver diseases. Even after the treatment, patients should be well aware regarding the wholesome and unwholesome food and habits and recurrence should be prevented. As occurrence of viral hepatitis are also increasing day by day chances of liver affliction is more than ever before. Alcohol being the threatening enemy of liver should be absolutely avoided once after knowing the infiltration of liver cell damage.

HOME REMEDIES

1. Aloe vera – pulp of the single leaf of the plant is taken and mixed with black salt and ginger. This should be taken every morning for 10 days.

2. Amla – 300 grams of powder of Indian gooseberry should be mixed with 100 grams of dried ginger powder. 1 teaspoonful of this should be taken with warm water twice in a day.

3. Bitter gourd – juice of bitter gourd mixed with small amount of salt is helpful.

4. Chicory juice – obtained from its flowers, seeds and roots is highly beneficial.

5. Dandelion Root – tea prepared from this root is useful.

6. Haritaki – Terminalia chebula powder mixed with jaggery in equal proportions (roughly 1.5-2 grams each) should be taken at least twice daily with warm water for 1-1.5 months.

7. Herbal decoction – Make a decoction of 1 teaspoon each of fennel seeds, ginger and coriander, 5 numbers of black pepper, garlic cloves and leaves of holy basil in 1-1.5 cups of water for 5 minutes. Strain it, add 1 teaspoon of honey once the liquid gets warm and take it twice daily after meals.

8. Kantakari – Solanumxanthocarpum is highly beneficial in treating hepatosplenomegaly i.e. enlargement of both liver and spleen.

9. Lemon juice – is an effective remedy for hepatomegaly. It reduces liver inflammation owing to its richness of vitamin C and other antioxidants and diuretic properties. For better results, it should be taken early in the morning, on empty stomach.

10. Onion – is diuretic, has cleansing properties, detoxifies liver and reduces liver inflammation, hence beneficial in hepatomegaly.

Tamarind tea – should be taken 2-3 times a day. Tamarind is a naturally detoxifying agent and reduces liver inflammation.

Other remedies –

• Papaya – eating fruit or drinking its juice

• Spearmint juice with sugar

• Orange juice on empty stomach

• Daily intake of long brinjals

• Green Tea

OTHER CLASSICAL MEDICINES AND HOME REMEDIES FOR LIVER DISEASES:

• Loha Bhasma (ash of iron) – with honey and ghee

• Shunti churna (ginger powder) with Loha Bhasma

• Loha bhasma with Gomutra (urine of cow)

• Powders of Ela (cardamom), Jeeraka (cumin seeds), Bhumyamalaki (Phyllanthus niruri) and Sita (sugar) – taken in equal quantities and mixed with ghee should be taken early in the morning

• Haridra churnam (turmeric powder) with curds early in the morning

HERBS USEFUL IN LIVER DISORDERS:

Sharapunkha (Tephrosa purpurea)

Bhoomyamalaki (Phyllanthus neruri)

Katukarohini (Picrorhiza kurroa)

Kumari (Aloe vera)

Aragwadha(Cassia fistula)

Bhringaraja (Eclipta alba)

Amalaki (Emblica officinalis)

Neeli (Indigofera tinctoria)

Rohitaka(Tecoma undulata)

Pippali – Long pepper (Piper longum)

Draksha – raisins (Vitis vinifera)

Guduchi – Giloy (Tinospora cardifolia)

Punarnava (Boerrhavia diffusa)

Nimba – Neem

Patola – pointed gourd

Parpataka(Pumaria parviflora)

Kiratatikta (Swertia chirata)

Bhoonimba (Andrographis paniculata)

Daruharidra (Berberis aristata)

AYURVEDIC MEDICINES FOR LIVER DISORDERS (YAKRIT VIKARA) :

Arogyavardhini Vati – used in the treatment of liver diseases, fever, skin diseases, etc.

Kumaryasava – used in the treatment of gastritis, urinary tract disorders etc.

Tamalaki choorna

Pathyakatphaladi kashaya

Rohitakarishtha – used in the treatment of liver and spleen related disorders, digestive problem like sprue, etc.

Pippalyasava – used in the treatment of anemone, piles, digestive complaints, sprue, liver complaints.

Guduchi satwa – used in Ayurvedic treatment of burning sensation of feet, bleeding diseases etc.

Punarnavasava – useful in gastritis, oedema, fiver and liver diseases.

Paripathadi khada

Bhoonimbadi khada – used in Ayurvedic treatment of fever, associated diarrhoea, cough, cold, asthma

Patola katurohinyadi kashaya – used in the treatment of anorexia, vomiting, skin diseases etc

Avipattikara choorna – used in the treatment of constipation. Avipattikar churna is a herbal powder mix.

Trailokyanatha Rasa

Chandraprabha Vati

Giloy Satwa

Vidaryadyasavam

Patolakaturohinyadi Kashayam

Punarnavadi Kashayam

Mahatiktakam Kashayam

Vasaguluchyadi Kashayam

Lohasavam

Rohitakarishtam

Mridwikasavam

Punarnavasavam

Pippalyasavam

Parthadyarishtam

Dantyarishtam

Chavikasavam

Kumaryasavam

Ayaskriti

Loha bhasma

Mandura Bhasma

Punarnava Mandura

Loha Mandura

Rasasindhoora

Mandura Vataka

Chinchadi leham

Danti haritaki leham

Drakshadi leham etc

RASODHI/BHASMA/PISTI-(120-250MG WITH MADHU/USHNODAKA)

- Jalodaradi rasa-(jayphala,tamra,snehusheera)

- Icchabhedi rasa-(kajjli,jayphala,sunthi)

- Narach rasa-(kajjali,trikatu,tankana)

- Loknath rasa-(kajjali,abhrak,loha,tamra)

- Mahabrahmi rasa-(parad,gandhak,haridra,triphala,nisoth,jayapala,manakshila)

- Treylokya sunder rasa-(parad,gandhak,tamra,abhrak,saindhav,vatsanabh,jeera,vidanga)

- Pippaliyadhya loha-(pippalimula,chitrak,abhrak,triphala,trikatu,trijata,loha)

- Pleehantak rasa-(tamra,rajat,abhrak,loha,gandhak,puskermula,trikatu,jayphala)

- Pleehari rasa-(parad,gandhak,tankan,trikatu,tripahala,jaypala,vatsanabh)

- Rohitak loham-(rohitak,triphala,trikatu,trinada,laha)

- Yakrutpalihari loha-(kajjali,loha,abhrak,loha,tamra,haridra,mankshila,jayphala)

VATI-(250-500MG WITH USHNA JALA)

- Abhaya vati-(snuhiksheer,tankan,haritakai)

- Arogyavardhani vati-(tamra,kutaki,abhrak)

- Agnitundi vati-(parad,gandhak,visa,ajmoda,kuchala)

- Bhedani vati-(gokshura,snehukshar,pippali curna)

CURNA-(3-6GM WITH MADHU/USHNODAKA)

- Narayan curna-(giloy kutaj,bilwa)

- Patoladhya curna-(patol,haridra,vidanga,triphala,nisoth,kampilaka)

- Shamundradhya curna-(samundri lavana,saindhav lavana,loha bhasma, trivrit)

- Punarnavadi curna-(punarnava,devdaru,haritaki)

- Rohitakadhya curna-(rohitak,yavakshar,chirayata,kutaki,motha)

- Arka lavana

KVATHA-(20-30ML WITH JALA)

- Punarnavadi kwatah-(punarnava,devdaru,kutaki)

- Punarnava asthak kvatha-(punarnava,bilwa,patol)

- Punarnavarista

- Dashamuladi kvatah-(dasamula,sunthi,punarnava)

- Punarnava asthak kvatha-(punarnava,bilwa,patol)

- Kumaryasava-(kumari,haritaki,loha,tamra)

- Arjunarista-(arjuna,draksha,madhuk)

- Abhayarista-(haritaki,vidang,draksha)

- Punarnavasava-(trikatu,triphala,gokshura,punarnava)

GHRITA/TAILA-(15-20ML WITH USNA JALA/MILK)

- Narach ghrita-(triphala,nisoth,snihiksheer,dantimula)

- Chitrak ghrita-(chitrak kvatha,ghrita)

- Pippali ghrita-(pippali,ghrita,sunthi,amlaki)

- Chitrak ghrita-(chitrak kvatha,ghrita)

AVLEHA/PAKA(20GM WITH DUGHDHA)

- Guda-pippali yoga-(guda,pippali,hinga,trikatu)